Test 1: lecture 4: fertility problems Flashcards
differentials
small ovaries/ streak ovaries
- hypoplasia- 63 XO karyotype
- anestrus?
- atrophied ovaries
how to diagnose 63 XO karyotype?
small ovaries
- Repeated palpations reveal no ovarian activity since estimated time of puberty.
- Ovaries are very small, smooth and firm. “streak ovaries”
- Extensive follicular atresia at birth
- Uterus and cervix are usually small and flaccid due to a lack of ovarian hormones.
- The mare is smaller in stature than expected.
- Definitive diagnosis by karyotype reveals only one X chromosome
ca a 63 XO mare have a foal
yes, if you transfer an embryo and give progestogen throughout gestation.
* they don’t have their own eggs and their repro tract is small
— most common ovarian tumor in mare.
Granulosa Cell Tumor (GCT)
- enlarged ovaries
- hard
- no ovulation fossa palpation
- abnormal hormones- ↑ testosterone, inhibin, AMH
- othere ovary will be small from ↑ inhibin
- behavior changes: anestrus, nymphomania, heterotypic/stallion like behavior
how to treat Granulosa Cell Tumor (GCT)
ovariectomy of GCT; may take up to 1.5 years for opposite ovary to regain function
- hard tumor, can’t feel ovulation fossa, behavior changes: anestrus, nymphomania, stallion-like behavior
Granulosa Cell Tumor (GCT) are multicystic
- no obvious ovulation fossa
behavior changes from GCT
Anestrus- These mares do not have an estrus cycle because the follicles will not mature and ovulate due to the high concentrations of inhibin. lack steroids
Nyphomania- These mares do NOT have elevated concentrations of estrogens. But if they are housed in proximity to stallions or amorous geldings they will not resist/reject the stallions advances because they have no progesterone. So they may appear to be in heat every day but in fact they really are not cycling.- lack steroids
Heterotypic behavior is behavior of the opposite sex. So male/stallion type behavior in a mare. ↑ androgens
what happens to other ovary with GCT
one big
one little from ↑ inhibin
test for GCT
blood test measuring hormone concentrations
* 48% have elevated testosterone
* 80% have elevated inhibin
* 98% have elevated anti Mullerian hormone
* Progesterone concentrations are usually < 1 ng/ml as most mares do not cycle and ovulate. Therefore the mare has no CL. We have seen a few pregnant mares with a GCT.
Histological section of a cystic space of a GCT. The diagnosis is made by the presence of piles of layers of granulosa cells lining irregularly shaped cystic spaces.
mare ovary, other ovary normal
Cystadenoma or Cystadenocarcinoma
— are rare but are often confused with a GCT. One should always have histology performed on any mass that is removed from the ovary.
Cystadenomas
— are germ cell tumors.
Teratoma
Neoplastic cells are pluripotent and can form many different cell types.
hematoma- will eventually regress on its own, does not effect cycling
* can still feel ovulation fossa
Epoophoron cyst will always be present on the ovary. Cystic remnant of the mesonephric tubules. Is not thought to cause problems. Just don’t confuse with a breed-able follicle.
— will always be present on the ovary. Cystic remnant of the mesonephric tubules.
Epoophoron cyst
- Is not thought to cause problems. Just don’t confuse with a breed-able follicle.
differentials for large ovaries
- GCT- other ovary small, behavior changes
- Cystadenoma
- teratoma
- hematoma- resolves on its own
- Epoophoron cyst- always there but its fine- old mesonephric tubules
- transitional ovaries- normal for the season
Patency of the oviducts is evaluated by
direct flushing of the oviduct or by placing starch grains, fluorescent beads, radioactive spheres on the surface of the ovary and examining for evidence of marker particles in uterine lavage effluent.
an accumulation of fluid in the oviduct due to an occlusion of the ends of the oviduct (may be congenital or acquired).
hydrosalpinx
how to treat hydrosalpinx if unilateral
if unilateral, surgical removal of
oviduct and ipsilateral/same side ovary.
Sonogram of the convoluted, anechoic fluid distended oviduct.
- hydrosalpinx
Parovarian cyst - cystic remnants of the mesonephric ducts; not pathologic. May be mistaken for a follicle during ultrasound examination.
* no treatment required
Germinal inclusion cysts or “fossa-cysts” are formed by peritoneal fragments that become imbedded in the ovary following ovulation. These “serosal” cysts may be large enough or numerous enough to be of clinical significance by possibly interfering with ovum transport in older mares.“
infundibulum
Fimbria cysts (Hydatid of Morgagni)
- only remove if too big, hemorrhage, adhesions
blocked oviduct- how to treat?
blocked oviduct- accumulation of type 1 collagen fibers
- PGE2 (endoscopic, directyly on duct) will cause isthmus to expel the globular mass- $$$
- misopostol (PGE1) intrauterine application
Dr ied exudate on the hindquarters of this mare that has chronic —
endometritis
three main defense machanisms to prevent bacterial infections in the uterus
- Anatomical barriers: Vulva and its underlying musculature, Vestibulovaginal ring, Cervix
-
Immune system-The presence of bacteria on the endometrium causes a rapid infiltration of neutrophils, immunoglobulins and serum proteins. Complement and opsonins bind to bacteria and enhance the neutrophils’ ability to phagocytize bacteria. The inflammation results in fluid production in the uterus. Note: Neutrophils from mares susceptible to endometritis have aa reduced ability to phagocytize bacteria as compared to mares
resistant to endometritis. - Mechanical uterine clearance-Myometrial contractions normally expel uterine debris and exudate through a relaxed cervix. Although most mares will have good uterine contraction initially after contamination mares susceptible to endometritis tend to have reduced myometrial contractions after 6-8 hours. This results in an accumulation of bacteria and inflammatory products in the uterus that will continue to activate the immune system and produce more uterine fluid.
three anatomical barriers to prevent endometritis
- Vulva and its underlying musculature
- Vestibulovaginal ring
- Cervix
how does immune system prevent endometritis
The presence of bacteria on the endometrium causes a rapid infiltration of neutrophils, immunoglobulins and serum proteins. Complement and opsonins bind to bacteria and enhance the neutrophils’ ability to phagocytize bacteria. The inflammation results in fluid production in the uterus. Note: Neutrophils from mares susceptible to endometritis have aa reduced ability to phagocytize bacteria as compared to mares resistant to endometritis.
how does mechanical uterine clearance prevent endometritis
Myometrial contractions normally expel uterine debris and exudate through a relaxed cervix. Although most mares will have good uterine contraction
initially after contamination mares susceptible to endometritis tend to have reduced myometrial contractions after 6-8 hours. This results in an accumulation of bacteria and
inflammatory products in the uterus that will continue to activate the immune system and produce more uterine fluid.
mare uterus
endometritis
- filled with hyperechoic fluid
- uterine horn distended
4 causes of endometritis
- Chronic contamination caused by pneumovagina or urovagina due to abnormal conformation or injury to the vulva and perineal region.
- Normal or abnormal parturition.
- Introduction of pathogenic bacteria at the time of copulation or uterine manipulation, particularly in mares with a low resistance to infection.
- Abnormal uterine motility, or obstruction of genital tract.
clinical signs of endometritis
- May be none. Mare does not show systemic signs of illness.
- Discharge from uterus.
- Fluid in uterus, seen on ultrasound examination.
- Uterine edema during diestrus.
- Infertility.
common causative organisms of endometritis
- Beta hemolytic streptococci ( Strep. zooepidemicus - 90%; Strep. equisimilis - 10%).
- E coli.
- Pseudomonas aeruginosa
- Klebsiella pneumoniae.
- Yeast – Candida sp.
- Fungi - Aspergillus and Mucor sp.
endometrium
endometritis: Severe granuloma evidenced by the large foci of lymphocytes and plasma cells in this endometrium.
how to treat endometritis
- flush uterus- with saline
- correct any physical abnormalities
- give meds to evacuate uterus (oxytocin)
- intrauterine antibiotics ∓ systemic antibiotics
- give prostaglandin to hasten estrus- better defenses
- good hygiene during exams and breeding
how to stimulate uterine evacuation for treating endometritis
- oxytocin- 20 min contractions
- prostaglandin- 4 hrs contractions
- exercise
- Ecbolics are drugs that stimulate contraction of the uterus.
can you give chlorhexidine into uterus
no, will slough and fuse uterus
how to treat steptococcal endometritis
β-hemolytic Streptococcus sp
* ceftiofur (excede)
* IM given q 4 days
how to treat E. coli endometritis
need to breakdown biofilm
* N-acetylcysteine- mucomyst
* then go back next day and give antibiotic infusions
* can also use 1% hydrogen peroxide to break down biofilm
wall of uterus
Periglandular fibrosis is severe and there is severe nesting of glands and severe cystic glandular distension associated with the fibrosis. This would be Category III-5 endometrium that would have difficulty carrying a foal to term.
why would horse not get pregnant
endometrial cyst
- embryo needs to touch all the walls of uterus, this would get in the way and cause lutinization and loss of pregnancy
what can cause endometrial transluminal adhesions
trauma; parturition; fetotomy; iatrogenic from infusion of caustic agents (chlorhexidine, Nolvasan®, iodine).
* Treatment - break down manually; may reoccur. Mare may benefit from progesterone during early pregnancy to override luteolysis.
Pyometra - accumulation of pus in the uterus
what type of tumor
Leiomyoma- uterine tumors are not common
Contagious Equine Metritis (CEM) is caused by
Taylorella equigenitalis
* Venereal transmission and contaminated equipment and
handling.
Contagious Equine Metritis (CEM) in mares vs stallions
mares- can usually clear infection on its own
stallion- asymptomatic and spread the disease
reportable disease- Taylorella equigenitalis, need to screen all imported horses, need special culture
how to repair poor perineal conformation
Caslick’s operation - episioplasty - suture dorsal portion of vulvar lips together. If it is true that poor vulvar/perineal conformation is inherited, this procedure may allow perpetuation of the condition within a breed by allowing mares to reproduce that would otherwise have been naturally eliminated from the “gene pool”. Severe cases may benefit from a Gadd’s procedure.
how to treat urovagina
- Surgical urethral extension.
- Improve body condition
- Episioplasty to prevent pneumovagina may alleviate urovagina
- In some mares, may be able to swab the urine out of the vagina
horse “ laying an egg”
persistent hymen
* manual rupture of dorsal portion of hymen (vestibulovaginal
fold).
how to treat bleeding from varicose blood vessels in vagina
preparation H (hemorrhoid cream)
why might you do clitoral sinusectomy
to prevent Contagious equine metritis
